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Migraine

Overview

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Migraine is a neurological disorder characterized by recurrent, severe headaches that often come with other symptoms such as nausea, vomiting, and sensitivity to light or sound. Migraines can be debilitating and significantly impact daily functioning. They often occur in phases, including prodrome, aura, headache, and postdrome.

Migraines can be debilitating and significantly impact daily functioning. They often occur in phases, including prodrome, aura, headache, and postdrome.

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Symptoms
  • Headache: Typically unilateral (one side of the head), throbbing or pulsating pain that can range from moderate to severe. The pain often worsens with physical activity.
  • Aura: Sensory disturbances that may occur before or during the headache phase, such as visual changes (flashing lights, zigzag lines), tingling or numbness in limbs, or difficulty speaking.
  • Nausea and Vomiting: Commonly associated with the headache phase.
  • Sensitivity to Light and Sound: Increased sensitivity to light (photophobia) and sound (phonophobia).
  • Neck Pain: Some individuals experience stiffness or pain in the neck.
  • Fatigue: Feeling unusually tired or fatigued before, during, or after the migraine.
Complications
  • Chronic Migraine: Frequent migraines (15 or more days per month) can become a chronic condition.
  • Medication Overuse Headache: Overuse of pain medications can lead to rebound headaches.
  • Disability: Severe migraines can significantly impact daily activities, work, and quality of life.
  • Associated Conditions: Migraines can be linked with other conditions like depression, anxiety, and sleep disorders.
Causes
  • Genetics: A family history of migraines can increase susceptibility.
  • Neurovascular Changes: Migraines are thought to involve changes in brain activity that affect blood vessels and neurotransmitters.
  • Hormonal Changes: Fluctuations in hormones, particularly in women, can trigger migraines (e.g., menstrual cycle, pregnancy, menopause).
  • Environmental Triggers: Factors like bright lights, strong odors, weather changes, or loud noises.
  • Dietary Triggers: Certain foods or drinks (e.g., alcohol, caffeine, aged cheeses, chocolate) can precipitate migraines.
  • Stress: Emotional or physical stress is a common trigger.
  • Sleep Patterns: Irregular sleep patterns or lack of sleep can contribute to migraines
Prevention
  • Identify Triggers: Keeping a migraine diary to identify and avoid potential triggers.
  • Healthy Lifestyle: Regular exercise, a balanced diet, and adequate sleep can help reduce the frequency of migraines.
  • Stress Management: Techniques such as relaxation exercises, meditation, or yoga can help manage stress.
  • Avoiding Overuse of Medications: Using medications as prescribed to avoid rebound headaches.
  • Regular Sleep Schedule: Maintaining a consistent sleep routine can help prevent migraines.
Risk Factors
  • Family History: Having a close family member with migraines increases the likelihood of developing them.
  • Age: Migraines often begin in adolescence or early adulthood but can occur at any age.
  • Gender: Women are more likely than men to experience migraines, often due to hormonal fluctuations.
  • Hormonal Changes: Women may experience migraines in association with their menstrual cycle, pregnancy, or menopause.
  • High Stress Levels: Elevated stress can increase the frequency and severity of migraines.
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How is it treated?

Acute Treatments:

  • Over-the-Counter Medications: NSAIDs (e.g., ibuprofen, aspirin) or acetaminophen can relieve mild to moderate migraines.
  • Triptans: Prescription medications (e.g., sumatriptan, rizatriptan) specifically designed to treat migraine attacks.
  • Anti-Nausea Medications: To control nausea and vomiting associated with migraines.

Preventive Treatments:

  • Medications: Daily preventive medications (e.g., beta-blockers, calcium channel blockers, antidepressants, anticonvulsants) to reduce the frequency and severity of migraines.
  • Lifestyle Modifications: Adopting healthy habits and avoiding known triggers.
  • Cognitive Behavioral Therapy (CBT): Can help manage stress and reduce migraine frequency.
  • Biofeedback: Techniques to control physiological responses and manage stress.

Alternative Therapies:

  • Acupuncture: Some find relief from migraines through acupuncture.
  • Supplements: Magnesium, riboflavin (vitamin B2), and coenzyme Q10 have been suggested as preventive measures.
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How is it Diagnosed?

Migraine is primarily diagnosed based on clinical evaluation since there are no definitive laboratory or imaging tests for confirmation. A thorough patient history is essential, focusing on headache characteristics including onset, frequency, duration, location, intensity, associated symptoms (like nausea, photophobia, phonophobia), and possible triggers. The International Classification of Headache Disorders (ICHD-3) criteria is commonly used to differentiate migraine from other types of headaches. A typical diagnosis includes headaches lasting 4 to 72 hours, unilateral location, pulsating quality, moderate to severe pain, and aggravation by physical activity, accompanied by nausea or sensitivity to light/sound.

A neurological examination is conducted to rule out secondary causes of headache such as brain tumors or infections. In cases where atypical features are present—such as a sudden onset ("thunderclap" headache), persistent neurologic deficits, or headache worsening with time—neuroimaging (MRI or CT scan) may be ordered. If aura symptoms are present, especially visual disturbances, a detailed description is obtained to differentiate from other neurological conditions like transient ischemic attacks or epilepsy. Additional investigations like EEG, lumbar puncture, or blood tests are not routinely required unless secondary causes are suspected. Diagnostic tools such as headache diaries and questionnaires may help in assessing pattern and severity.

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FAQs

  • A migraine is a neurological condition characterized by intense, throbbing headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraines can last for hours or days.

Common triggers include:

  • Stress
  • Certain foods or drinks (e.g., caffeine, alcohol, chocolate)
  • Hormonal changes
  • Lack of sleep
  • Bright lights or loud noises

Symptoms include:

  • Severe, throbbing pain (usually on one side of the head)
  • Nausea or vomiting
  • Sensitivity to light, sound, or smells
  • Visual disturbances (aura) in some cases

Treatments include:

  • Over-the-counter pain relievers (ibuprofen, acetaminophen)
  • Prescription migraine medications (triptans, CGRP inhibitors)
  • Preventive medications for chronic migraines
  • Lifestyle changes to avoid triggers

  • Yes, managing stress, maintaining regular sleep patterns, staying hydrated, and avoiding known triggers can help reduce the frequency of migraines. Keeping a migraine diary to track triggers may also help.
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